Artificial spinal disc, insertion tool, and method of insertion

ABSTRACT

An artificial spinal disc is provided for unilateral insertion from the posterior side of the patient and includes a pair of plate members with a bearing associated with one plate member and a depression associated with the other for permitting limited flexibility of patient movement. An outrigger is provided which includes rods extending through the pedicles on one side of each of two adjacent vertebrae and posts connected to the rods which provide an artificial facet joint. A method of insertion of the artificial spinal disc hereof includes cutting channels for receiving longitudinally extending ribs on the plate members and removing the natural facet joint in order to permit insertion of the artificial spinal disc. A tool for insertion of the artificial spinal disc acts as a drill guide for creating a passage through the pedicles.

RELATED APPLICATION

This application is a divisional application of U.S. patent applicationSer. No. 10/973,795, filed Oct. 26, 2004, incorporated by referenceherein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention broadly concerns an artificial disc, insertion tool, andmethod of insertion for treating conditions of the human spine. Moreparticularly, it is concerned with providing a system and method whichadvantageously permits insertion of the artificial disc from theposterior region of the patient and provides a unilateral approach withposterior stabilization through fixation through the pedicles of thevertebrae while still allowing the patient to enjoy a range of motion inthe area of the artificial disc.

2. Description of the Prior Art

A number of conditions can result in damage or deterioration of one ormore intervertebral discs of the human spine (hereinafter “discs”). Adisc may become damaged by external injury or degenerative disc diseasedue to advanced age in combination with other factors, just to mentiontwo examples. One condition which results in significant pain andpotential nerve damage, and may require surgery, is a herniated disc.

One type of surgery which has benefitted patients with disc problems isfusion of the vertebrae adjacent the disc. In this surgery, the naturaldisc is replaced with a spacer and the vertebrae are fixed relative toone another. While such surgery provides a degree of relief to thepatient, it necessarily limits flexibility of the spine, which presentsa disadvantage for patients with an active lifestyle. Anotherdisadvantage is the placement of greater loads on the adjacentvertebrae, resulting in what is commonly known as “adjacent segmentdisease.” Later efforts in the treatment of human disc problems is theuse of artificial human discs. Conventionally, this treatment involvesthe removal of the natural human disc and the insertion of two platesthrough the abdomen, i.e. the anterior side of the patient. The reasonthat insertion through the anterior of the patient is thought to be theconventional method is that it avoids the necessity of passing theartificial disc past one or more of the spinal facets or articularprocesses, or the spinal cord. These body parts present significantobstacles to attempts to insert an artificial disc posteriorly. Oneproblem with such conventional disc replacement systems and methods isthat the anterior insertion of the disc does necessitate surgicalinvolvement of the two major blood vessels, the vena cava and the aorta.Anterior insertion requires spreading the abdominal muscles and theaorta and vena cava in order to gain access to the vertebrae and thedisc. Because rupture of either of the vena cava or aorta islife-threatening, such surgery requires the attendance of both avascular surgeon as well as a spinal surgeon. Another problem is thedifficulty presented in providing artificial discs in two pieces whichprovide satisfactory support and balance along a single load bearingpoint as close to the center load line of the spine as possible.

As a result, there has developed a need for an improved artificial discwhich may be inserted unilaterally from the posterior side of thepatient.

Moreover, there has developed a need for an improved artificial discwhich provides support for the spinal column while providing the desiredflexibility of movement.

Furthermore, there is a need for an improved artificial disc whichminimizes the risk of injury to the patient during the surgical process.

In addition, there is a need for an improved method of insertion of anartificial disc which reduces the potential risk to the patient duringsurgery, minimizes or eliminates the necessity of spreading theabdominal muscles, and yet provides satisfactory insertion andstabilization of the disc.

SUMMARY OF THE INVENTION

These and other objects will be largely met by the artificial spinaldisc, insertion tool and method of insertion of the present invention.That is to say, the present invention provides a device which isparticularly designed for posterior insertion, and further providesinsertion in a unilateral direction, while being minimally invasive tothe patient. In this regard, only a portion of the patient's naturaldisc needs to be removed to receive the new artificial disc hereof.

Broadly speaking, the present invention includes an artificial discwhich includes two opposing plate members each having an outrigger whichincludes a facet to replace the natural facet joint between the inferiorarticular process of one vertebra and the superior articular process ofthe adjacent vertebra. Portions of these inferior and superior articularprocesses are removed during the surgery to permit insertion of theplates from one side of the posterior position of the vertebra. Theplate members are complementally configured to permit limited relativemotion therebetween. They are also particularly configured with the ribssubstantially centered longitudinally and provided with a recess in theribs to enable mounting of the outriggers. Further, the plate membersinclude a rounded nose configured complementally with thecross-sectional curvature of the natural disc and a relieved edgeconfigured to avoid involvement with the spinal cord. One of the platemembers is thus preferably provided with a convex portion which faces aconvex portion of the opposing plate member. Ribs extend along theopposite surfaces of the plate members for limiting lateral motion ofthe plate members once inserted, and permit a unilateral insertion ofthe plate members between the adjacent vertebrae. The plate members maybeneficially be provided with a bio-ingrowth surface to promote bonegrowth and thus more secure attachment to the vertebra. The outriggersinclude rods extending through the pedicles of the vertebrae which areattached to the plate members. In addition, the outriggers includerespective superior and inferior posts connected to the respective rods,and facet heads on each post which are complementally configured topermit limited relative movement therebetween. The outriggers serve asartificial facets to replace the facet joint between the articularprocesses removed during surgery, so that support for the patient'sspine is not compromised by removal of one of the facets of thevertebra. The other facet of the vertebra can also be replaced ifdesired using pedicle screws or a second attachment to the plate membersof the artificial disc. The artificial facets may be enclosed in aflexible skirt, or alternatively a rigid collar can be provided insurrounding relationship to the artificial facets to help maintain thefacets in proximity and further limit the amount of relative movementbetween the facets.

The present invention also beneficially provides for the cut forreceiving and locating the plate members to be made along a single lineof insertion—i.e. unilaterally—from generally the posterior of thepatient. The provision for a unilateral cut through the natural disc andalong each of the adjacent vertebrae provides a good support againstlateral movement of the plate members, a favorable interface with thebone, leaves a portion of the natural disc intact for support andcushioning, and makes it easier for the surgeon to make the right cutand avoid errors.

The invention hereof also includes a novel tool for use duringattachment of the outriggers. The tool functions as a guide for use indrilling the channel through the pedicles for receiving the outriggerrods. The tool, which includes a carrier and a drill guide, isadvantageously temporarily mounted on one of the plate members and thenthe other, or two such tools can be employed simultaneously, so that thechannel which is drilled is related to the position of the plate membersafter insertion into the spine, and more particularly the opening intothe recess of the plate members. Moreover, the tool is adjustablewhereby the surgeon can accommodate variations in individual physiologyso that the channel is most advantageously located for the patient. Thedrill guide is preferably tubular in configuration, having a centralaxis, and beneficially the central axis intersects at a common point—theopening to the recess of the plate members—when the guide is shifted onthe carrier so that the channel created by the drill remains alignedwith the opening into which a part of the outrigger is inserted into theplate member.

The present invention also includes an improved method of insertion ofan artificial disc into a patient. Broadly speaking, the method includescutting a passage through the natural disc and respective slots inadjacent vertebrae from a generally posterior position of the patient,removing at least a part of one of the spinal superior articularprocesses and at least a part of one of inferior articular processes onthe adjacent vertebra. The surgeon then inserts the plate members alongthe slots in a unilateral approach, first using a specialized spacer forcreating additional space between the adjacent vertebrae, if necessary.This spacer includes a handle and a block fixed thereto, so that theblock turns with the handle to which it is affixed. The block is widerin one direction and narrower in a direction perpendicular to the onedirection, and preferably is rectangular with rounded corners. The blockis inserted into a tunnel cut in the natural disc between adjacentvertebra, with the narrow width of the block oriented on the spinalaxis, and then turned so that the wider width is oriented substantiallyon the spinal axis to increase the spacing between the adjacentvertebrae. The tool used for drilling the channels through the pediclesis then attached in sequence to each of the plate members (or two suchtools may be used simultaneously) and the channels are drilled throughthe pedicles to permit attachment of the outriggers. The rods of theoutriggers are then inserted through the channels and connected to theirrespective plate members, and the posts are affixed and secured to therods.

It is believed that the present invention will attain the goal ofreducing the pain experienced by the patient and restoring most of theoriginal range of motion of the spine. Moreover, it should reduce therisks attendant to anterior insertion of artificial discs whereby thepresence of a vascular surgeon will no longer be necessary. These andother benefits will be readily appreciated by those skilled in the artwith reference to the drawings and the detailed description set forthbelow.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a fragmentary rear elevational view of the patient's spineshowing the plate members of the artificial disc inserted and the leftfacet joint removed, but before outriggers of the artificial disc havebeen attached;

FIG. 2 is a fragmentary side elevational view of the patient's spineshowing the plate members of the artificial disc inserted and the toolattached thereto for acting as a drill guide for the channels to receivethe outrigger rods;

FIG. 3 is a horizontal cross-sectional view taken along line 3-3 of FIG.1 with portions of adjacent vertebrae removed for clarity, and with anarcuate weight-bearing member of one of the plate members shown inphantom lines, and showing the tool attached to the plate members;

FIG. 4 is an enlarged, fragmentary vertical sectional view taken alongline 4-4 of FIG. 3, showing the spacer in position between adjacentvertebrae before insertion of the plate members;

FIG. 5 is a end elevational view showing the tool attached to the platemembers;

FIG. 6 is an enlarged, fragmentary vertical cross-sectional view takenalong line 6-6 of FIG. 3, showing the artificial disc plate membershaving complemental weight-bearing surfaces and recesses for receivingthe rods of the outriggers;

FIG. 7 is a fragmentary vertical cross-sectional view through a portionof the spine showing the channels drilled in the pedicles of thevertebrae in alignment with the openings in the plate members;

FIG. 8 is an enlarged, fragmentary vertical cross-sectional view similarto FIG. 7 but showing the rods of the outriggers inserted in thechannels, with the upper rod shown prior to expansion in the recess andthe lower rod after expansion, and with multiaxial gripping headsmounted on the rods;

FIG. 9 is an enlarged, fragmentary vertical cross-sectional view similarto FIG. 8, showing the posts with the artificial facet joint thereoncoupled to the multiaxial gripping heads on the rods;

FIG. 10 is an exploded view of the tool for guiding the drill, with theartificial disc plate members shown in partial section;

FIG. 11 is a perspective view of the tool as shown in FIG. 10, andshowing a drill inserted in the guide of the tool for drilling thechannel into one of the pedicles for receiving the rod;

FIG. 12 is an exploded view of the artificial disc, showing the platemembers, the rods and posts of the outriggers, and the artificial facetwith its casement bisected for clarity;

FIG. 13 is an enlarged vertical sectional view of the artificial dischereof, showing an alternative configuration of the artificial facetsand rigid collar instead of a flexible skirt surrounding the artificialfacets, the collar being provided with an arcuate-shaped inner wall andpermitting one of the rods to pass through an opening in the collar andmove relative to the collar;

FIG. 14 is a fragmentary vertical sectional view of the artificial discas shown in FIG. 13, wherein the upper facet is turned and shifteddownwardly relative to the lower facet; and

FIG. 15 is a fragmentary horizontal sectional view taken approximatelyon line 15-15 of FIG. 14 to illustrate the camming effect into the innerwall of the collar caused when the convex face of the upper facet turnsor slides upwardly a sufficient distance relative to the concave face ofthe lower facet.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now to the drawings, an artificial spinal disc 20 inaccordance with the present invention is shown in FIGS. 9 and 12 andbroadly includes first plate member 22 and second plate member 24 with aconnecting outrigger 26. The invention further includes a tool 28 usedin drilling channels for receiving the outrigger 26, and a spacer tool30. The artificial spinal disc 20 is designed for use between adjacentfirst vertebra 32 and second vertebra 34. As used herein, the terms“first vertebra” and “second vertebra” are used merely as a referencesto distinguish between two adjacent, superior and inferior vertebra, andnot in the medical sense as in “sixth cervical vertebra.” As seen inFIGS. 1, 2 and 3 for example, each of the vertebrae 32 and 34 present avertebral foramen 36 for receiving therein the spinal cord 38, a body 40which provides a weight bearing capacity for the spinal column 42, leftand right pedicles 44 and 46, left and right transverse processes 48 and50, left and right superior articular processes 52 and 54, left andright inferior articular processes 56 and 58, and a spinous process 60.The inferior articular processes 56 and 58 of first vertebra 32 and thesuperior articular processes 52 and 54 of second vertebra therebelowwork together to provide natural facet joints 62 which provide supportand a limited range of movement between the vertebrae. In addition, anatural human disc 64 is located between the first and second vertebra.

In greater detail, the first plate member 22 includes an elongated panel66 having a first surface 68 for abutment with the first vertebra 32 anda second surface 69 generally facing the second plate member 24 and thesecond vertebra 34, a longitudinally extending, laterally centered rib70 extending toward the first vertebra 32 from the first surface 68, andan arcuate, generally convex bearing 72 extending toward the secondvertebra 34 from the second surface 34. The panel 66 has a surroundingedge 74 which includes a rounded nose 76, generally straight andrelatively parallel side edges 78 and 80, a generally straight back edge82 extending substantially perpendicular from side edge 78, and relievededge 84 which is inwardly arcuate and extends from the side edge 80 tothe back edge 82. The rounded nose 76 is generally tapered in thelongitudinal direction so that when a line is extended perpendicular tothe junction of the side edge 78 and the nose 76, the opposite side edge80 extends past this perpendicular line, as seen in FIG. 3. The roundednose thus mirrors the rounded anterior margin of the body 40 and thenatural disc 64. The relieved edge 84 is recessed to avoid or at leastminimize any intrusion of the plate member 22 with the spinal cord. Theback edge 82 further includes a longitudinally extending hole 86 whichis oriented along the longitudinal axis of the plate member 22 andparallel to the longitudinal extension of the rib 70. The hole 86 ispreferably internally threaded for mounting tool 28 thereto, as shown inFIGS. 10 and 11. Bearing 72 is located on second surface 69 in aposition not necessarily laterally or longitudinally centered on thepanel 66, but rather positioned as shown in FIG. 3 to be centered onwhat is substantially the weight bearing axis of the spinal column. Theplate member 22 may be cast or machined of any suitable metal such ascobalt-chrome stainless steel or titanium, and except for bearing 72,provided with a bio-ingrowth coating or texture, such as, for example,hydroxyappetite or porous beads. Bearing 72 may be cast or machinedalong with the remainder of the plate member 22 so that it is integrallyformed of metal, such as cobalt-chrome stainless steel or titanium, ormay be attached to the first surface and provided of a durable andfriction-resistant synthetic material such as nylon. The bearing 72 isshown as being domed and semi-hemispherical, but could also be ellipsoidor of other arcuate shapes.

Rib 70 includes a remote surface 87 and a pair of generally angled,divergent (in a direction from the remote surface 87 toward the surface68) side surfaces 88 and 90. A recess 92 extends in longitudinalalignment into the rib 70 and panel 66. The recess 92 may be cylindricaland/or threaded, but most preferably is generally frustoconical inconfiguration and has an axis which is angled relative to the remotesurface 87 to provide a desired angle of attachment and approach for theoutriggers, as seen in FIGS. 6, 7, 8, 9 and 12. The frustoconical shapeof the recess 92 is such that an inner wall 94 generally diverges as thedepth into the plate member 22 increases.

Plate member 24 shares similar features with plate member 22. In thatregard, second plate member 24 includes an elongated panel 96 having afirst surface 98 for abutment with the second vertebra 34 and a secondsurface 99 generally facing the disc 64 and the first vertebra 32, alongitudinally extending, laterally centered rib 100 extending towardthe second vertebra 34 from the first surface 98, and an arcuate,generally concave bearing-receiving depression 102 extending inwardlyinto the panel 96. The panel 96 has a surrounding edge 104 whichincludes a rounded nose 106, generally straight and relatively parallelside edges 108 and 110, a generally straight back edge 112 extendingsubstantially perpendicular from side edge 108, and relieved edge 114which is inwardly arcuate and extends from the side edge 110 to the backedge 112. The rounded nose 106 is generally tapered in the longitudinaldirection so that when a line is extended perpendicular to the junctionof the side edge 108 and the nose 106, the opposite side edge 10 extendspast this perpendicular line. Thus, as with panel 66, the rounded nose106 of the panel 96 thus mirrors the rounded anterior margin of the body40 and the natural disc 64. The relieved edge 114 is recessed to avoidor at least minimize any intrusion of the plate member 24 with thespinal cord. The back edge 112 further includes a longitudinallyextending hole 116 which is oriented along the longitudinal axis of theplate member 24 and parallel to the longitudinal extension of the rib110. Plate members 22 and 24 are thus designed so that their respectivepanel edges are substantially congruent when placed in longitudinalalignment in superior-inferior relationship, with the holes 86 and 116being oriented in parallel relationship. The hole 116, as with hole 86,is preferably internally threaded for mounting tool 28 thereto, as shownin FIGS. 10 and 11. Bearing-receiving depression 102 is located onsecond surface 99 in a position not necessarily laterally orlongitudinally centered on the panel 66, but rather positioned as shownin FIG. 3 to be centered on what is substantially the weight bearingaxis of the spinal column. The plate member 22 may be cast or machinedof any suitable metal such as cobalt-chrome stainless steel or titanium,and except for bearing-receiving depression 102, provided with abio-ingrowth coating or texture, such as, for example, hydroxyappetiteor porous beads. Bearing-receiving depression 102 has a curvaturecomplemental to the curvature of the bearing 72, but in order to permitrocking of the bearing 72, the depth of the bearing-receiving depression102 is less than the height of the bearing 72. Thus, the respectivesurfaces 69 and 99 of panels 66 and 96 have a space S therebetween whenthe panels are in an initial, parallel orientation. The bearingreceiving depression 102 is machined or otherwise formed in the platemember 24 to be smooth, and is preferably integrally formed of metal,such as cobalt-chrome stainless steel or titanium. If desired, afriction-resistant coating of lining of a durable and friction-resistantsynthetic material such as nylon may be provided.

Rib 100 includes a remote surface 118 and a pair of generally angled,divergent (in a direction from the remote surface 118 toward the surface98) side surfaces 120 and 122. A recess 124 extends in longitudinalalignment into the rib 110 and panel 96. The recess 124 may becylindrical and/or threaded, but most preferably is generallyfrustoconical in configuration and has an axis which is angled relativeto the remote surface 118 to provide a desired angle of attachment andapproach for the outriggers, as seen in FIGS. 6, 7, 8, 9 and 12. Thefrustoconical shape of the recess 124 is such that an inner wall 126generally diverges as the depth into the plate member 24 increases.

Outrigger 26 provides an artificial facet joint 127. The outrigger 26includes first and second rods 128 and 130 respectively connected tofirst and second plate members 22 and 24. The first and second rods 128and 130 each mount respective first and second posts 132 and 134 havingrespective, mating, complementally configured first and second facets136 and 138 on the posts. A retaining skirt 140 encloses the first andsecond facets 136 and 138.

The first and second rods 128 and 130 each include a connector 142 forattachment to the plate members at one end and a coupler 144 forattachment to the posts at the other end. The connectors 142 permitremovable fastening of the rods to respective ones of the plate members22 and 24. In the preferred embodiment illustrated in the drawings, theconnectors 142 include a threaded pin 146 received in a tubular cannula148 of each rod 128 and 130. The tubular cannula 148 each have a slottedtip 150 distal to the coupler 144 for insertion into the recesses 92 and124. The slotted tip 150 includes a plurality of finger-like extensions152 each having an enlarged, bulb-like end 154. The cannula 148 have anenlarged, rounded knuckle 156 at the proximate end 158 adjacent to andreceived by the coupler 144, and an externally threaded barrel 160intermediate the tip 150 and the rounded knuckle 156. The tubularcannula 148 also have internal walls 162 defining a passage 164 forreceiving the threaded pin 146 therein. As may be seen in FIG. 8, forexample, the initial configuration of the passage 164 interior of theslotted tip 150 is convergent in a direction from the coupler toward thetip 150, such that the diameter of the bulb-like end 154 is initiallyapproximately the same as the unthreaded portion 166 of the tubularcannula remote from the threaded barrel 160. At least a portion 168 ofthe internal walls 162 also have threads 170 thereon. The roundedknuckle 156 is rounded along its distal surface, and includes at itsproximate surface slots 172 or other tool-receiving slot or socket suchas for receiving a hex or other wrench to permit driving and removal ofthe tubular cannula 148. The threaded pin 146 is complementally sizedfor axial insertion into the passage 164 and has threads 174 thereon forpermitting advancement and removal of the pin from the tubular cannula148. The pin 146 preferably includes a shank 176 and a head 178, one ofwhich is provided with the threads 174. As illustrated, the head 178 isexternally threaded for engagement with the threads 170 of the tubularcannula 148. The head 178 also includes a hex socket 180 or similarstructure whereby a tool, such as a screwdriver or an Allen wrench, maybe inserted for advancing the pin 146 into the tubular cannula 148. Thecoupler 144 preferably is provided as a multi-axial head 182 andincludes a collar 184 having arcuate inner walls 186 which are sized andconfigured to receive the rounded knuckle 156 in snap-on engagement,whereby once a tubular cannula 148 is inserted into the multi-axial head182 with the rounded knuckle 156 installed in the collar 184, therounded knuckle 156 may swivel and pivot within collar 184. Themulti-axial head 182 further includes opposed ears 188 and 190 havinginternally facing opposed teeth 192 thereon. The opposed teeth 192 serveboth to grip a post inserted between the ears 188 and 190 and tothreadably receive a locking cap 194.

The first and second posts 132 and 134 are inserted between the ears 188and 190 whereby their respective first and second facets 136 and 138 arein opposed engagement. The facets 136 and 138 are complementallyconfigured, one facet having a generally concave mating surface 198 andthe other having a convex mating surface 196 and both being inclined ina superior to inferior direction. It is to be understood that either thesuperior facet 136 or the inferior facet 138 may have either a convex ora concave face, but as illustrated the convex mating surface 196 isprovided on the superior facet while the concave mating surface 198 isprovided on the inferior facet 138. Retaining skirt 140 is provided overthe facets 136 and 138 to aid in their initial retention. The skirt 140is preferably tubular (shown bisected in FIG. 12) and provided of aflexible, resilient and biologically inert synthetic resin material. Theskirt may be held in position by clamps 200, drawstrings, resilientbands at each end, or by its own resiliency, for example. For ease ofuse, the posts including the facets may be provided already connected bythe skirt 140 so that the surgeon need not assemble the skirt around thefacets during surgery.

In order to facilitate insertion of the artificial disc 20 between thevertebrae, and because of possible compression of the natural disc 64,it may be necessary to provide additional spacing therebetween.Additional space between adjacent vertebrae may be provided by spacer 30shown in FIG. 4. The spacer 30 is configured for insertion in a tunnelinitially cut in the natural disc 64. The spacer 30 includes a block 202connected to an elongated handle 204. The block 202 is generallyrectangular in transverse shape, having a primary dimension A which issmaller than a secondary dimension B transverse thereto, parallel longsides 206 and parallel short sides 208 perpendicular to the long sides206, and rounded corners 210 which facilitate turning of the spacer 30between the vertebrae.

Further, the tool 28 of the present invention is provided to aid thesurgeon installing the artificial disc with regard to aligning the drillfor drilling channels in the pedicles for the rods of the outrigger 26.As shown in FIG. 7, the surgeon may employ one tool 28 sequentially oruse two tools 28 on respective ones of the plate members 32 and 34. Thetool 28 broadly includes a carrier 212, and a drill guide 214, and ispreferably made of a corrosion-resistant metal such as stainless steel.

Carrier 212 is preferably provided to include a slide 216 and anelongated rod 218 having a threaded stem 220 at one end thereof, thethreaded stem being sized and configured for threading into thelongitudinally extending holes 86 and 116 in the back edges of each ofthe plate members 32, 34. However, it may be appreciated that the stem220 and its receiving longitudinally extending holed 86 and 116 could besmooth, or polygonal, may be provided with a snap connection, or othermounting configurations for holding the tool 28 temporarily on therespective plate member. The opposite end of the elongated rod 218 isprovided with a mounting section 222 for receiving the slide 216. Themounting section 222 may be threaded or include a snap connection. Inthe embodiment illustrated, the mounting section 222 is provided as aflat-sided flange 224 for receiving the protractor thereon. The slide216 includes a coupler 226 complementally configured with the mountingsection 222 for facilitating coupling of the arcuate-shaped slide to therod 218, and a beam 228. The beam 228 is preferably arcuate inconfiguration, with the coupler 226 preferably laterally offsetting thebeam 228 relative to the rod 218. A set screw 230 may be provided to actas a securement to hold the mounting section 222 to the rod 218. Thedrill guide 216 includes an elongated tube 232 and a slider 234. Theslider 234 mounts the tube 232 thereon and includes structure defining aslot 244 which is complementally configured to the beam 228 so that thedrill guide 216 fits snugly to the beam but the position of the slider234 may be adjusted along the beam. The tube 232 has a central axis A,and advantageously, the central axis A will always orient toward therecess in the rib of the respective plate member 22, 24 to which thetool 28 is mounted, such that the central axis A always intersects atthe same point as the drill guide is shifted along the beam 228 of thecarrier 212. The slider 234 offsets the tube 232 relative to the beam228 so that there is no interference between the beam and the tube 232,and also whereby the tube 232 is substantially co-planar with thecarrier 212. A thumbscrew 236 or other fastener may threaded through acompanion opening in the slider 234 if additional securement to hold thedrill guide stationary in use is necessary. The tube 232 is sized toreceive a drill bit 238 attached to a drill 240, the diameter of thetube 232 and the drill bit 238 preferably being sized so that a channel242 created by the drill bit 238 is substantially of the same diameteras the outside diameter of the unthreaded portion 166 of the rods asseen, for example, in FIG. 9.

A desired method of insertion of the artificial spinal disc 20 of thepresent invention is also provided. After initial incisions andspreading of the skin and muscles to gain access to the spinal regionfrom a posterior direction (preferably with the patient in a supineposition, the surgeon cuts away a portion of the inferior articularprocess 56 of the first vertebra 32 and a portion of the superiorarticular process 52 of the second vertebra 34 immediately therebeneathin order to provide a route for the introduction of the plate members 22and 24 therethrough. The surgeon then cuts a tunnel 244 into the naturaldisc of the patient of a width substantially corresponding to the widthof the plate members between the respective side edges of one panel 78and 80 and 108 and 110 of the other panel. If the spacing between thefirst vertebra 32 and the second vertebra 34 have been reduced to toogreat an extent, the block 206 of the spacer 30 is inserted into thetunnel 244 in an initial position as shown in dashed lines in FIG. 4.The block 206 is then turned 90° to the position indicated in solidlines in FIG. 4 to cause additional space to be created between thefirst vertebra 32 and the second vertebra 34. The spacer may then beremoved. Thereafter, a chisel or similar tool is used to cut troughs 246and 248 into the body 40 of each of the vertebra 32 and 34. The troughs246 and 248 oppose one another and are oriented in a parallel directionto the tunnel and preferably substantially centered laterally. Further,the troughs 246 and 248 are sized to receive respective ribs 70 and 110.

The surgeon then places the plate members 22 and 24 in matingjuxtaposition with one another whereby the bearing 72 is received in thebearing receiving depression 102. The surgeon then slides the assembledplate members 22 and 24 into the tunnel 244 with the ribs 70 and 110received in and sliding along respective trough 246 and 248 until thecenter of the bearing is located substantially at the load bearing axisof the spinal column in the region between the first vertebra 32 and thesecond vertebra 34 as illustrated in FIGS. 1, 3 and 6. It may thus beappreciated that the surgeon is employing a substantially unilateralapproach from the posterior direction. In addition, the ribs 70 and 110act both as a guide during insertion of the plate members 22 and 24 butalso provide additional stabilization to minimize movement of theartificial disc off of the weight bearing axis of the spinal column.Further, a substantial portion of the natural disc of the patient isleft intact for additional cushioning and support and the bone ingrowthcoating or surface on the plate members 22 and 24 should help promotenatural fixation of the artificial disc 20.

Because the natural facet joint between the adjacent inferior articularprocess and the superior articular process on one side of the firstvertebra 32 and the second vertebra is lost as a result of the insertionof the plate members 22 and 24 from one side in a posterior position,the present invention provides the outrigger 26 to provide an artificialfacet joint. After the plate members 22 and 24 are in place, the surgeonthen attaches the tool 28 to the plate members 22 and 24 by affixing thecarriers to the holes 86 and 116 as shown, for example, in FIGS. 2, 3,10 and 11. The surgeon moves the drill guide 216 along the beam of theslide 216 until the channel 242 to be drilled is aligned to pass throughsubstantial bone mass through the pedicle 44 on the desired side of eachof the first vertebra 32 and the second vertebra 34. Beneficially, thedrill guide 216 remains aligned with the entry of recesses 92 and 124along the top of the ribs so that the surgeon will need to be concernedonly with finding the appropriate bone mass in the pedicle knowing thatthe drill guide will align the drill bit with the respective recess 92or 124 without it being seen. The surgeon then inserts the drill bit 238into the tube 232 and drills the channel 242 through the pedicles 44 onone side of each of the first vertebra 32 and second vertebra 34 forreceiving the rods 128 and 130. With the channels thus drilled as shownin FIG. 7, the tool 28 may then be removed from the plate members 22 and24.

The rods 128 and 130 are then mounted on their respective ribs 70 and110 of the plate members 22 and 24 as illustrated by FIG. 8. The surgeoninitially inserts the rod as shown with respect to rod 128 in FIG. 8.While the threads may be omitted from the externally threaded barrel 158on the exterior of the rods, the threads thereon aid in holding the rodin position. Additional attachment support is provided by advancing thepin 144 along the passage. As the pin 146 advances, the extensions 152of the slotted tip 150 expand so that the bulb-like ends 154 spread andengage the inner surfaces 94 and 126 of the frustoconically shapedrecesses 92 and 124, respectively. Because of the recesses 92 and 124have a slightly greater transverse dimension at their end wall asopposed to their entry opening on the surface of the rib, the bulb-likeends 152 expand and help lock the rods in place once the pins are fullyseated as shown in FIG. 9.

With the rods 128 and 130 fully inserted as desired, the surgeon theninstalls the posts 132 and 134 onto the multi-axial head 182 bypositioning the posts between the gripping surfaces of the ears 190 and192 of each multi-axial head. As may be seen in FIG. 9, the multi-axialheads 182 permit pivoting and rotation of the ears so that the posts 132and 134 may be in superposed alignment, with the facets 136 and 138 inmating concave-convex relationship. The posts may be secured in thisposition further by threading thereon the locking cap 194 as shown inFIG. 9. Any excess length of the posts 132 and 134 extending beyond themulti-axial heads 182 may be cut away by the surgeon. The primary weightto be carried along the spinal column will pass between the platemembers, with the facets 136 serving as a limiter against excessivetwisting or vertical movement rather than for bearing weight. The skirt140 being preplaced around the facets 136 and 138, the incision may beclosed in accordance with ordinary surgical procedures.

Among the many benefits provided by the present invention are theminimization of risk of damage to the spinal cord by adopting aposterior, trans-pedicular approach from the side, the fact that oneside of the vertebrae involved are left alone because of the unilateralapproach which is minimally invasive, minimizing the possibility thatthe artificial disc will spin or shift one inserted in position,retaining substantial flexibility in the joint to avoid transferral ofstress to other vertebrae, and the ability to leave the anteriorligament intact.

One further benefit of the present invention is that should the needarise, the artificial disc 20 hereof may be readily removed from thepatient. By using threaded connections and a unilateral approach, iffusion of the adjacent vertebrae later becomes necessary, the entireartificial disc hereof may be removed. First, to remove the outrigger26, the surgeon removes the locking caps 194 from the multi-axial headsand prises the posts 132 out from between the ears 190 and 192. Thesurgeon may then gain access to the pin within the tubular cannula, andusing a wrench or similar tool, back out the threaded pin from thetubular cannula in which it is received. Because the rounded knuckle 156includes slots 172 or other tool receiving structure, once the pin 146is backed out, the extensions 152 of the slotted tip 150 are free tocollapse as the tubular cannula is threaded out of the bone and the tip150 is withdrawn from the respective recess. With the rods removed, thesurgeon may insert threaded bolts or other tools into the holes 86 and118 to use to gain a purchase on the plate members and remove them alongthe tunnel initially cut through the natural disc. Alternatively, if itwas necessary to fix the first vertebra 32 against movement relative tothe second vertebra, the plate members 22 and 24 could be left inposition, but a solid bridge-type structure inserted either between themulti-axial heads or be attached between the plate members 22 and 24 andconnected by threaded fasteners inserted into the holes 86 and 116.

As an alternative to the flexible retaining skirt 140 illustrated inFIGS. 9 and 12, a collar 250 may be utilized in connection with theartificial facets 136 a and 138 a. The collar 250 is initiallymanufactured having an upper cap 252 and a lower housing 254 whichreceive the posts 132 and 134 respectively. The post 132 passes throughan access 256 in the upper cap 252 and the post 134 passes through anopening 258 in the lower housing 254. The access 256 generally presentsa greater clearance between the collar 250 and the post 132 than theclearance between the collar 250 and the lower post 134 provided byopening 258 as illustrated in FIGS. 13 and 14. The upper cap 252 andlower housing 254 are then assembled and secured by welding, mechanicalfasteners or the like along their respective mating edges so that thefacets 136 a and 138 a are retained within the assembled collar 250,which is thereby provided as a unit along with the posts 132 and 134, sothat the assembly including the collar 250 enclosing the artificialfacets 136 a and 138 a, along with the posts 132 and 134, is provided tothe surgeon ready for installation on the respective rods. Preferably,the lower post 134 is secured to the housing 254 at the opening 258 bywelding, adhesive or a mechanical fastener so that no relative motion ispermitted between the lower post 134 and the housing 254.

The collar 250 is configured with an inner wall 260. The inner wall 260has a side surface 262 which is preferably generally arcuate inhorizontal cross section, and most preferably, the side surface 262which is generally ovoid in horizontal cross-section, beingsubstantially circular in cross section along an anterior portion 264and more prolate or eccentrically shaped along a posterior portion 266as illustrated by FIG. 15. The inner wall 260 also closely conforms tothe respective outer surfaces 268 and 270 of the facets 136 a and 138 abut permits limited relative movement therebetween. Most preferably, theinner wall 260 includes an upper wall surface 272 which is positionedclosely adjacent an upper margin 274 of the superior facet 136 a so thatthe mating, convex and concave faces 196 and 198 of the facets 136 a and138 a are maintained in constant engagement and the facets do notseparate when in the full distraction position as shown in FIG. 13.Moreover, the side surface 262 is most preferably substantially uprightand perpendicular to the upper wall surface 272 along the anteriorportion 264, but the posterior portion 266 is slightly inclined so as topresent a more conical configuration when viewed in verticalcross-section as seen in FIGS. 13 and 14. The outer surface 270 of theinferior facet 138 a is preferably provided with a lip 278 which extendsposteriorly so that in horizontal cross-section, it has an ovoid shapecomplemental to and closely adjacent the inner wall 260, as seen in FIG.15. The outer surface 268 of the superior facet 136 a is preferablygenerally ovoid in cross-section, such that the anterior side 280 of thesuperior facet 136 a is generally circular while the posterior side 282is prolate and more closely conforms to the configuration of the innerwall 260, having a generally tapered posterior side 282 such that thedistance of the posterior side 282 from the anterior portion 264 of theinner wall 260 increases in a downward direction away from post 132. Theconfiguration of the upper facet 136 a relative to the collar 250 issuch as to limit separation between the facets 136 a and 138 a, butstill providing sufficient clearance between the posterior side 282 ofthe outer surface 268 of the superior facet 136 a and the posteriorportion 266 of the inner wall 260 to permit limited sliding of thesuperior facet 136 a downwardly along the inferior facet 138 a andlimited relative rotational movement of the superior facet 136 arelative to the inferior facet 138 a.

The relative configurations of the collar 250 and the facets 136 a and138 a provide improved stability while permitting limited relativemovement between the posts 132 and 134 and their respective facets 136 aand 138 a in the artificial spinal disc 20 hereof. FIG. 13 shows theposition of the posts and facets 136 a and 138 a when the facets are intheir fully distracted position. As patient moves (as illustrated here,bends so that the upper vertebra 32 moves clockwise relative to thelower vertebra 34), the superior facet 136 a is permitted to slidedownwardly along the inferior facet 138 a until the outer surface 268engages the side surface 262 of the inner wall 260, thereby limiting theamount of relative movement between the facets 136 a and 138 a, and alsoproviding additional stability for the patient. As the upper facet 136 amoves beyond the position shown in FIG. 14, the outer surface 268 willengage the inclined posterior portion of the side surface 262 of theinner wall. The extended lip on the inferior facet 138 a enables theconcave and convex mating surfaces to substantially remain in contactand provide continuous support in the region as well as continuousresistance so that the patient does not experience rapid slippage as thefrictional engagement changes.

In addition, a limited amount of relative rotational movement ispermitted between the facets 136 a and 138 a. FIGS. 14 and 15 illustratethat as the superior facet 136 a begins to rotate relative to theinferior facet 138 a, the generally convex mating surface or face 196begins to ride up along the opposing, and fixed, concave mating face 198of the inferior facet 138 a. When the upper facet 136 a shifts downalong the lower facet 138 a, an axis A of the inferior post 132 remainsstationary, while the axis B of the superior post 134 moves off of itsinitial alignment with axis A in a generally anterior to posteriordirection. As shown in FIG. 15, when the upper facet 136 a also haslimited rotational movement relative to the lower facet 138 a, the axisB also moves to one side of an anterior to posterior plane bisecting thelower facet 138. The upper facet 138 a is permitted to continue thisrelative rotational movement as the patient twists until the outersurface 268 of the superior facet 136 a moves into engagement with theside surface 262 of the inner wall 260 of the collar 250. Thecombination effect of the convex and concave face engagement with thecamming effect when the upper facet engages the inner wall providesincreased resistance as the patient's torso twists up to the point ofengagement, as well as a beneficial centering function.

Advantageously, the configuration of the facets 136 a and 138 a and thecollar 250 is complemental and synergistic in regard to limiting theamount of patient movement. That is to say, the more movement thepatient undertakes to cause the upper facet 136 a to slide downwardlyalong the lower facet 138 a, the less relative rotational movement ispermitted. This is because when the upper facet 136 a fully slidesdownwardly, it comes into full engagement with the side surface 262 sothat no relative rotational movement is permitted. This inhibitsexcessive movement which might lead to injury to the patient. Thus, theconfiguration of the inner wall 260 benefits the patient in which theartificial spinal disc has been implanted by permitting some movement,but also by limiting the amount of movement based on a combination ofphysical factors related to how much stress the patient is placing onthe spinal region.

Although preferred forms of the invention have been described above, itis to be recognized that such disclosure is by way of illustration only,and should not be utilized in a limiting sense in interpreting the scopeof the present invention. Obvious modifications to the exemplaryembodiments, as hereinabove set forth, could be readily made by thoseskilled in the art without departing from the spirit of the presentinvention. By way of example only, the rods of the outrigger 26 could beattached to the plate members by threading or other means of fastening,a separate synthetic resin or metal member could be used as a weightbearing member between the plate members each having a generally convexbearing receiving surface, and a bio-ingrowth surface coating could beapplied to the exterior of the rods to promote bone growth therearound.In addition, the collar 250 could have a tapered inner wall to allowsliding movement while maintaining contact with the facets, could beconfigured with a generally cylindrical inner wall 260, or both facetscould be free to move relative to the collar. It is also to beunderstood that the plate members could be configured to receiveadditional outriggers whereby both natural facet joints could be removedand artificial facets provided in lieu thereof.

The inventors hereby state their intent to rely on the Doctrine ofEquivalents to determine and assess the reasonably fair scope of theirinvention as pertains to any apparatus not materially departing from butoutside the literal scope of the invention as set out in the followingclaims.

1. An apparatus for attaching an outrigger to an artificial spinal disc,said artificial spinal disc being for location within an intervertebralspace between first and second adjacent vertebra, said space normallyoccupied by a natural spinal disc, said apparatus comprising: anartificial spinal motion preservation disc configured to preserve motionwhen implanted in an intervertebral space; a carrier including anarcuate segment fixed on the distal end of the carrier; a tubular drillguide operably coupled with the arcuate segment and continuouslytranslatable there along for radial travel of the tubular drill guide ina cephalad/caudal direction; and a connection structure operable todetachable connect the carrier with the artificial disc, wherein theconnection structure coupled the carrier to the artificial disc, andwherein said drill guide includes a tubular member having a centralaxis, and wherein said central axis of the tubular member continuouslyintersects a common point as said drill guide is translated along saidcarrier in a cephalad/caudal direction, and wherein the common pointspatially intersects with a position on the artificial disc, wherein theartificial disc comprises a bore disposed on an outer surface of theartificial disc, and the common point spatially intersects with aposition in said bore.
 2. An apparatus as set forth in claim 1, whereinthe arcuate segment has a fixed end and a free end, and the carrierfurther comprises a radially extending elongated body having first andsecond ends; wherein the first end of the radially extending elongatedbody is affixed to the fixed end of the arcuate segment.
 3. An apparatusas set forth in claim 2, wherein the connection structure is disposed atthe second end of the radially extending elongated body.
 4. An apparatusas set forth in claim 1, wherein said drill guide includes a tubularmember having a central axis, and wherein said central axis of thetubular member continuously intersects a common point as said drillguide is translated along said carrier, and wherein the common point isspatially offset from the radially extending elongating body.
 5. Anapparatus as set forth in claim 4, wherein the radially extendingelongated body defines a longitudinal axis extending along its length,and the common point is spatially offset from the longitudinal axisdefined by the radially extending elongated body.
 6. An apparatus as setforth in claim 1, wherein the connection member comprises a threadedmember.
 7. An apparatus as set forth in claim 4, wherein the connectionmember comprises a threaded member.
 8. An apparatus as set forth inclaim 1, wherein the artificial disc comprises a pair of adjacent platemembers.
 9. An apparatus as set forth in claim 8, wherein the adjacentplate members are configured to articulate relative to one another forpreserving motion when implanted in an intervertebral space.